Otomatik çivi tabancasýnýn neden olduðu sternumdan geçen penetran kardiyak travma: Olgu sunumu

Otomatik çivi tabancasýnýn neden olduðu el yaralanmalarý, bu makinelerin inþaatlarda kullanýlmasýyla yaygýn olarak ortaya çýkar. Bununla birlikte, kardiyotorasik bölge yaralanmalarý atipiktir. Bu yazýda, bir çiviyi çýkarýrken yanlýþlýkla sternumdan kalbe ulaþýlan acil cerrahi müdahale olgusunu sunmaktayýz. Yirmi dört yaþýndaki bir erkek, bir þantiyede dar bir alanda çalýþýrken, otomatik havalý çivi tabancasýnýn hava hortumuna takýlýp düþtü. Alet kiþiye doðru bakarken yanlýþlýkla tetik çekilmiþ ve sternuma bir çivi girmiþ. Göðsünde aðrý hisseden hasta, yakýndaki bir ortopedi kliniðine yürü-müþ ve ardýndan tedavi için hastanemize sevk edildi. Muayenede çivi prekordiyal göðüs orta hattýna tamamen gömülüydü. Akciðer grafisi ve toraks bilgisayarlý tomografi görüntülerinde prekordiyal bölgeden sternuma giren ve anterior mediastene ulaþan çubuk þeklinde bir çivi görüldü. Çivi ucu pulmoner arter ve aort arasýnda durmaktaydý; pulmoner arterin ana gövdesine dokunuyordu. Masif kanama ve enfeksiyon olasýlýðý düþünülerek ayný gün, 45 mm uzunluðundaki (2 mm çapýnda) çivinin çýkarýlmasý için acil cerrahi uygulandý. Yardýmcý dolaþým sistemi kullanýlmadý ve intraoperatif kan transfüzyonu gerekmedi. Hasta ayný gün ekstübe edildi. Ameliyat sonrasý yedinci günde çekilen bilgisayarlý tomografi, endiþe verici bir durum olma-dýðýný ve enfeksiyon belirtisi olmadýðýný doðruladý. Hasta ameliyat sonrasý sekizinci gün taburcu edildi ve yürüyerek evine döndü. Hasta poliklinikte altý ay takip edildi; enfeksiyon durumu veya anormal hemodinamik bulgu saptanmadý. Bu olgu, baþlangýçta önemsiz görünebilecek çivi tabancasý yaralanmalarýnýn dikkatli bir þekilde deðerlendirilmesi gerektiðini göstermektedir.

Sharp cardiac trauma through the sternum caused by an automatic nail gun: A case report

Automatic nail gun injuries to the hand commonly occur with the use of these machines in construction. However, such injuries to the cardiothoracic area are atypical. Herein, we report a case of emergency surgery to remove a nail, which was accidentally shot through the sternum and reached the heart. A 24-year-old man was working in a narrow space at a construction site, where he tripped over the air hose of an automatic pneumatic nail gun. The trigger was accidentally pulled, while the machine was facing his direction, and a nail entered his sternum. The patient felt chest pain, walked to a nearby orthopedic clinic, and then was transferred to our hospital for treatment. On examination, the nail was completely embedded in the midline of the precordial chest. Chest X-ray and computed tomography (CT) images showed a rod-shaped nail penetrating the sternum from the precordial region and reaching the anterior medi-astinum. The nail tip was located between the pulmonary artery and the aorta; it was touching the main trunk of the pulmonary artery. Emergency surgery was performed to remove the 45-mm-long nail (2 mm in diameter) on the same day, considering the possibility of massive bleeding and infection. An auxiliary circulatory system was not used, and intraoperative blood transfusion was not required. The patient was extubated on the same day. On post-operative day 7, CT confirmed that there were no issues of concern and no signs of infection. The patient was discharged on post-operative day 8 and returned home on foot. The patient was followed up for 6 months in the outpatient clinic, and there were no signs of infection or abnormal hemodynamics. This case demonstrates the need for careful assessment of nail gun injuries, which may initially appear insignificant.